Factors associated with neonatal near miss in Brazil

• Main Authors: Theonas Gomes Pereira (Author), Daniele Marano da Rocha (Author), Vânia Matos Fonseca (Author), Maria Elisabeth Lopes Moreira (Author), Silvana Granado Nogueira da Gama (Author)
• Format: Book
• Published: Universidade de São Paulo, 2020-12-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.
• Notes: 1518-8787; 10.11606/s1518-8787.2020054002382
• Keywords: Near Miss; Healthcare; Pregnancy Complications; Risk Factors; Socioeconomic Factors; Maternal-Child Health Services; Public aspects of medicine; RA1-1270
• Source: Revista de Saúde Pública, Vol 54 (2020)

ABSTRACT OBJECTIVE: This study evaluates the association between sociodemographic factors, maternal characteristics, organization of health services and neonatal near miss in public and private maternity hospitals in Brazil. METHODS: This is a prospective cohort of live births from the Nascer no Brasil survey, carried out between 2011 and 2012. Variables were established from the literature and organized on three levels: distal, intermediate, and proximal. The assessment was performed based on results of the bivariate analyzes and their respective p-values, with a significance level <0.20, using the Wald test. For multivariate analysis, the variables contained at the distal level were inserted, preserved in the model when significant (p < 0.05). This was also done when adjusting the intermediate and proximal levels. RESULTS: At the distal level, no variable was significantly associated with the outcome. At the intermediate level, mother's age greater than or equal to 35 years (relative risk - RR = 1.32; 95%CI 1.04-1.66), cesarean delivery (RR = 1.34; 95%CI 1.07-1.67), smoking (RR = 1.48; 95%CI 1.04-2.10), gestational hypertensive syndrome (RR = 2.29; 95%CI 1.98-3.14), pre-gestational diabetes (RR = 2.63; 95%CI 1.36-5.05) and twin pregnancy (RR = 2.98; 95%CI 1.90-4.68) were variables associated with the outcome. At the proximal level, inadequate prenatal care (RR = 1.71; 95%CI 1.36-2.16) and the hospital/maternity being located in a capital city (RR = 1.89; 95%CI 1.40-2.55) were associated with neonatal near miss. CONCLUSIONS: The results show that neonatal near miss was influenced by variables related to the organization of health services and by maternal characteristics.